Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.
Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, People's Republic of China.
Drug Des Devel Ther. 2023 Jun 13;17:1741-1752. doi: 10.2147/DDDT.S407905. eCollection 2023.
This study aimed to explore the effects of different injection rates of propofol on postoperative cognition in elderly patients undergoing laparoscopic inguinal hernia repair.
A total of 180 elderly patients who planned to undergo laparoscopic inguinal hernia repair were randomly divided into three groups: slow injection of propofol (V-Group, 30 mg kg h); medium injection of propofol (V-Group, 100 mg kg h) or fast injection of propofol (V-Group, 300 mg kg h). Propofol was induced by microinfusion pump, and the depth of anesthesia was monitored by bispectral index (BIS). Propofol and remifentanil were continuously infused during anesthesia maintenance and adjusted according to BIS. The primary outcome was the use of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to measure the incidence of postoperative cognitive decline (POCD) in elderly patients on the first and seventh postoperative day. Secondary outcomes included induced dose of propofol, incidence of burst suppression and maximum electroencephalographic (EEG) effect of propofol (BIS-min) during induction.
The incidence of POCD on the first and seventh day postoperatively was similar among the three groups (P > 0.05). However, with the increase of propofol injection rate, induced dose of propofol, incidence of burst suppression and BIS-min during induction, the number of patients requiring vasoactive agents were significantly increased ( < 0.001). Multivariate regression analysis showed that the brief duration of burst suppression during induction did not affect the occurrence of POCD, while age and duration of hospitalization were risk factors for POCD.
For elderly patients undergoing laparoscopic inguinal hernia repair, lowering the injection rate of propofol (such as 30 mg kg h) cannot decrease the incidence of early POCD, but reduces induction dose of propofol and use of vasoactive drugs, making the patient's hemodynamics more stable.
本研究旨在探讨不同异丙酚注射速率对老年患者腹腔镜腹股沟疝修补术后认知的影响。
本研究纳入了 180 名计划行腹腔镜腹股沟疝修补术的老年患者，将其随机分为三组：异丙酚缓慢注射组（V-组，30mg/kg/h）、异丙酚中速注射组（V-组，100mg/kg/h）或异丙酚快速注射组（V-组，300mg/kg/h）。异丙酚通过微量输液泵诱导，麻醉维持期间通过脑电双频指数（BIS）监测麻醉深度。持续输注异丙酚和瑞芬太尼，并根据 BIS 进行调整。主要结局是使用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估老年患者术后第 1 天和第 7 天认知功能下降（POCD）的发生率。次要结局包括诱导时异丙酚的诱导剂量、爆发抑制的发生率和异丙酚的最大脑电效应（BIS-min）。
三组患者术后第 1 天和第 7 天 POCD 的发生率相似（P＞0.05）。然而，随着异丙酚注射速率的增加，诱导剂量、爆发抑制的发生率和诱导时的 BIS-min 增加，需要血管活性药物的患者数量也显著增加（＜0.001）。多变量回归分析显示，诱导时爆发抑制的持续时间短暂不会影响 POCD 的发生，而年龄和住院时间是 POCD 的危险因素。
对于行腹腔镜腹股沟疝修补术的老年患者，降低异丙酚的注射速率（如 30mg/kg/h）不能降低早期 POCD 的发生率，但可减少异丙酚的诱导剂量和血管活性药物的使用，使患者的血流动力学更稳定。
